H. Breithaupt, HEPATOTOXIC SIDE-EFFECTS OF ANTIRHEUMATIC DRUGS AND ANTIRHEUMATIC TREATMENT IN PREEXISTING LIVER-DAMAGE, Zeitschrift fur Rheumatologie, 53(4), 1994, pp. 250-254
In about 1% of patients treated longterm with nonsteroidal antiinflamm
atory drugs severe liver damage occurs with an increase of transaminas
es of more than eightfold. Therefore, measurement of the liver enzymes
every 4 to 8 weeks is mandatory. When the transaminase values are gre
ater than 60 U/l, the therapy must be discontinued. Methotrexate may a
lso induce an increase of the transaminases, especially within the fir
st 3 months of therapy. Severe hepatotoxicity, however, rarely occurs.
Therefore, transient increases up to 60 U/l may be tolerable, but per
sistent transaminases higher than 60 U/l require termination of methot
rexate therapy.